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Chapter 10: Nutrition during Pregnancy and Lactation
Test Bank
MULTIPLE CHOICE
1. Nutritional needs during pregnancy are affected by

a. the mother's age.
b. the sex of the infant.
c. the mother's food cravings.
d. whether the mother works.
ANS: A
Nutritional needs during pregnancy are affected by the mother’s age along with height and
prepregnancy weight.
DIF: Cognitive Level: Application REF: 174-175 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance
2. A pregnant woman's energy needs must be met in order to

a. spare vitamins.
b. spare adipose stores.
c. prevent fetal deformity.
d. spare protein.
ANS: D
Adequate energy is necessary to spare protein. If inadequate kilocalories from energy are
provided, then protein will be used for energy. Protein increase is approximately 50% more
than the average adult requirement.
DIF: Cognitive Level: Knowledge REF: 174-175 TOP: Nursing Process: Planning
3. Daily kilocalorie needs during the second trimester exceed normal requirements by
approximately _____ kcal.
a. 100
b. 200
c. 340
d. 500
ANS: C
The national standard recommends an increase of 340 kcal/day during the second trimester
and approximately 450 kcal/day during the third trimester of pregnancy.
DIF: Cognitive Level: Knowledge REF: 174 TOP: Nursing Process: Planning
4. The amount of extra protein required by pregnant women compared with nonpregnant women
is approximately _____ g/day.
a. 10
b. 15
c. 25
d. 30
ANS: C
Protein intake should increase 25 g/day during pregnancy on top of nonpregnancy needs. This
increase is approximately 50% more than the average adult requirements.
DIF: Cognitive Level: Knowledge REF: 175

TOP: Nursing Process: Assessment
5. Increased protein is necessary in pregnancy for

a. preventing gestational diabetes.
b. sparing carbohydrates for energy needs.
c. growing maternal tissues.
d. preventing pregnancy-induced hypertension.
ANS: C
Increased protein is necessary in pregnancy for sparing carbohydrates for energy, rapid
growth of the fetus, development of the placenta, growth of maternal tissues, increased
maternal blood volume, and amniotic fluid.
6. A good source of calcium during pregnancy is

a. orange juice drink.
b. lean ground beef.
c. milk.
d. baked beans.
ANS: C
Calcium is essential for fetal development of bones and teeth as well as for the mother’s own
body needs. Milk or milk substitute products and generous amounts of green vegetables and
enriched or whole grains are good sources of calcium.
DIF: Cognitive Level: Application REF: 175 TOP: Nursing Process: Planning
7. A good source of iron during pregnancy would be

a. watermelon
b. orange juice
c. macaroni and cheese
d. lean ground beef
ANS: D
Iron is distributed primarily in meat, eggs, vegetables, and fortified cereals.
DIF: Cognitive Level: Knowledge REF: 175-176

TOP: Nursing Process: Application
8. Iron needs increase during pregnancy because of

a. maternal constipation.
b. increased maternal blood volume.
c. increased maternal metabolic rate.
d. poor iron absorption during pregnancy.
ANS: B
Iron needs are increased during pregnancy for increased hemoglobin synthesis required for the
greater maternal blood volume as well as for the baby’s necessary prenatal storage of iron.
9. Adequate folate in the periconceptional period helps prevent

a. cretinism.
b. mental retardation.
c. neural tube defects.
d. gestational diabetes.
ANS: C
Folate builds mature red blood cells throughout pregnancy and is particularly needed during
the early periconceptional period to ensure healthy embryonic tissue development and prevent
malformation of the neural tube.
10. The B-complex vitamins are required in greater amounts during pregnancy because
a. fetal demands for the vitamins are high.
b. more hemoglobin is synthesized.
c. the vitamins are excreted in greater quantities.
d. metabolic activities increase.
ANS: D
The B vitamins are needed in increased amounts because of their vital role as coenzyme
factors in energy production and protein metabolism.
11. Daily intake of vitamin C should be increased during pregnancy because it

a. is an important factor in tissue growth.
b. plays an important role in protein synthesis.
c. is necessary for the energy-producing pathways.
d. is important in development of bones in the fetus.
ANS: A
Vitamins A and C are needed in higher amounts during pregnancy because they are both
important factors of tissue growth.
12. Drinking 3 to 4 cups of milk a day during pregnancy is recommended because it is a good
source of
a. folate.
b. iron.
c. vitamin D.
d. vitamin C.
ANS: C
Milk is a good source of vitamin D along with calcium, phosphorus, and magnesium for fetal
development of bones and teeth as well as for the mother’s own bodily needs.
DIF: Cognitive Level: Application REF: 175

TOP: Nursing Process: Implementation
13. Appropriate snack choices for a pregnant woman with morning sickness may include
a. a meal of hot soup and Gatorade.
b. lemonade with added sugar and peppermint sticks.
c. a glass of hot decaffeinated tea.
d. whole-wheat toast with a small amount of light butter and a small piece of fruit.
ANS: D
Small, frequent meals and snacks that are fairly dry and consisting mostly of easily digested
energy foods (e.g., carbohydrates), mostly cold foods, with liquids between meals, are
recommended for women with morning sickness.
DIF: Cognitive Level: Application REF: 179-180

14. A condition of severe, prolonged, and persistent vomiting during pregnancy is called
a. hyperemesis gravidarum.
b. placenta previa.
c. gestational diabetes.
d. preeclampsia.
ANS: A
Hyperemesis gravidarum is morning sickness in early pregnancy that progresses from a mild
state to a severe and prolonged state requiring medical treatment.
DIF: Cognitive Level: Knowledge REF: 179 TOP: Nursing Process: Diagnosis
15. A food choice to help alleviate constipation during pregnancy is

a. figs.
b. chocolate.
c. white bread.
d. saltines.
ANS: D
Helpful remedies for constipation include high-fiber foods such as whole grains, vegetables,
dried fruits, and other fruits and juices.
16. An acceptable ending pregnancy weight for a normal-weight woman whose prepregnancy
weight is 125 lb is _____ lb.
a. 130 to 135
b. 135 to 145
c. 145 to 150
d. 150 to 160
ANS: D
Weight gain for a normal-weight woman with a body mass index of 19.8 to 26 is 25 to 35 lb.
Thus, 125 lb + 25 to 35 lb = 150 lb to 160 lb.

17. Total weight gain during the first trimester should be approximately _____ lbs.
a. 1 to 2
b. 2 to 4
c. 6 to 10
d. 10 to 15
ANS: B
Recommended weight gain in the first trimester of pregnancy is approximately 2 to 4 lbs.
18. A pregnancy is considered high risk if the mother

a. is 16 years old.
b. is vegetarian.
c. works full time.
d. exercises 4 or 5 times per week.
ANS: A
Nutritional risk factors at the onset of pregnancy include age 18 years or younger or 35 years
or older; frequent pregnancies; poor obstetric history or poor fetal performance; poverty;
bizarre or trendy food habits; abuse of nicotine, alcohol, or drugs; chronic disease with
therapeutic diet; and weight less than 85% or more than 120% of normal.

MSC: NCLEX: Physiological Integrity: Physiological Adaptation
19. A pregnant adolescent is at risk because she

a. does not know how to care for herself.
b. has not established good eating habits.
c. is still in a growth stage of development.
d. will not know about the pregnancy until after the fetal organs have formed.
ANS: C
A pregnant adolescent is at risk because adolescence itself is a stage of growth. The
physiologic demands of the pregnancy can compromise the teenager’s needs for her own
unfinished growth and development.

20. A very overweight pregnant woman older than 30 years of age is at high risk for
a. anemia.
b. gestational diabetes.
c. edema.
d. phenylketonuria.
ANS: B
Risk factors for women who are more than 120% of standard weight or who have a body mass
index of more than 26 include gestational diabetes. During pregnancy, there is an increased
metabolic workload along with an increased volume of blood and its load of metabolites,
including glucose. Some of this extra glucose “spills over” into the urine.

21. During pregnancy, women should be encouraged not to

a. exercise.
b. have sexual intercourse.
c. drink alcoholic beverages.
d. drink decaffeinated coffee.
ANS: C
Social habits of alcohol, cigarette, and drug use can cause fetal damage and are
contraindicated during pregnancy. Extensive, habitual use of alcohol leads to the
well-documented fetal alcohol syndrome.

22. The most common cause of anemia during pregnancy is

a. folic acid deficiency.
b. lack of intrinsic factor.
c. iron deficiency.
d. vitamin C deficiency.
ANS: C
Iron-deficiency anemia is most common during pregnancy.
23. Of the following, the best source of folate would be
a. fruit juices.
b. green leafy vegetables.
c. whole grains.
d. citrus fruits.
ANS: B
Folate is found in food sources such as green leafy vegetables, legumes, yeast, chicken, beef,
and liver.

24. The finding of glycosuria during a routine laboratory test may suggest that the woman has
a. anemia.
b. gestational diabetes.
c. phenylketonuria.
d. hypertension.
ANS: B
Gestational diabetes presents with glycosuria or sugar spilling over into the urine. Other
predisposing factors include age 30 years and older; those who are overweight and have a
history of previously unexplained stillbirths; delivery of large babies weighing 9 lbs or more;
habitual abortions; births of babies with multiple congenital defects; and family history of
diabetes or ethnicity associated with a high incidence of diabetes.

25. High blood pressure and the accumulation of protein in the urine may be signs of
a. preeclampsia.
b. hyperemesis.
c. alcoholism.
d. gestational diabetes.
ANS: A
High blood pressure can be fatal to the mother and fetus. If symptoms progress with the
accumulation of proteinuria, the condition is referred to as preeclampsia.

26. Three important factors that support adequate lactation are

a. diet, exercise, and vitamin supplements.
b. intake of dairy products, fluids, and rest.
c. diet, fluids, and rest and relaxation.
d. intake of bland foods and adequate fluids.
ANS: C
Successful lactation requires an adequate diet, including energy and nutrients for both the
process and product, adequate fluid for adequate milk production, and rest and relaxation to
enhance the production and letdown reflexes of breast-feeding.
27. Nutrition counselors should encourage pregnant teenagers to

a. avoid fast food.
b. eat foods from all the basic food groups.
c. drink fat-free (skim) rather than whole milk.
d. eat foods high in dietary fiber.
ANS: B
Pregnant teens should consume foods from all five basic foods groups to support fetal
development as well as their own growth and development needs.

28. Advantages of breast-feeding for the mother include

a. less fluid retention.
b. rapid weight loss.
c. fewer maternal infections.
d. convenience and economy.
ANS: D
The advantages of breast-feeding include benefits to both mother and baby, such as the ability
of human milk to meet the unique needs of the infant and convenience and economy.
29. During pregnancy, intake of caffeine for a 132-lb woman should be

a. avoided.
b. limited to 100 mg of coffee per day.
c. limited to 300 mg of coffee per day.
d. unlimited in quantity.
ANS: C
During pregnancy, caffeine intake should be limited. The overall conclusion is that moderate
amounts of caffeine (5 to 6 mg/kg/day) throughout the day do not have negative effects on
reproduction or fetal health. Thus, 60 kg (132 lb)  5 = 300 mg of caffeine/day.

30. The best food choice that provides a source of folate is

a. spinach.
b. lemonade.
c. corn chips.
d. sausage patty.
ANS: A
Food sources of folate include enriched flour and grains, green leafy vegetables, legumes,
soybeans, wheat germ, orange juice, asparagus, and broccoli.

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in such a hurry—not able to see ahead . . . Did you come on
business?"
"Nothing pressing. It can wait till another day. I wanted to

know how your father was."
He debated silently how soon to go after Mr. Trevelyan; a

step already resolved on. Jean had looked so forlorn when
he entered, that he would not at once leave her.
"I should have sent for you, if only I could have felt sure—
But if Barclay had died meantime—"
"Yes; I can hardly think you would have been justified."
"I am glad you think so," with a more restful look. After a
break, she resumed, "I was telling you, the other day, all
about Barclay—the sort of life his has been. I wanted to ask
you a question; only we were interrupted. It puzzles me
sometimes how a man like that—brought up as he was—
how he can help being what he is . . . I mean—can he help
it? . . . If he has inherited all sorts of evil ways—and if all
his associations were so bad—things he could not alter—
doesn't it seem as if he must have grown into his present
shape, without any choice of his own? And if that is true,
how can he be responsible for it?"
"No man is responsible for what he cannot help."
"Or for its results—"
"Or for results; so far as he has been absolutely powerless

to prevent those results."
"If Barclay had had a different home and education, he

would have turned out differently, of course."
"To some extent, yes—either better or worse. You and I
cannot judge how far he might, if he would, have changed
his associations—or resisted them. We don't know where he
has or has not deliberately yielded to evil."
"But isn't yielding or resisting a matter of will? And isn't will

inherited?"
"Yes—partly, no doubt. The natural will may be strong or

weak; and it becomes stronger or weaker through training."
"And if a man's will is paralysed—?"
"I doubt if any sane man's will is paralysed. Most people

have will enough to do what they like. Apparent paralysis is
commonly shown only in apparent powerlessness to do
what they don't like."
"But if the will is what it is, through heredity and training—"

pronounced Jean slowly—"and if a man can't control either
the heredity or the training—then I don't see how he can
help being what he is?"
"Not badly put, for a one-sided view of the question. But

you must take care not to lose sight of the other side—the
absolute freedom of the will—its God-given freedom. No
man living can be forced into evil. It is a matter of
inducement, not of force. The will sways right or left,
according to the strength of the inducements offered—
inducements to self-pleasing on the one hand, inducements
to right-doing on the other hand."
"That brings one again to a man's surroundings. But

suppose Barclay's surroundings have been all bad? Suppose
he has never once had the strong-enough inducement to do
right?"
"Jean, are you trying to climb upon the judgment-seat?"
asked Jem, in a quiet low voice; and a flush rose to her
face. "No wonder your task proves puzzling! Omniscient
Eyes are needed there to discriminate—to award due praise
or blame. I suppose there is nothing in which we blunder
more fearfully."
"Then one ought not to look into the question?"
"Look into it as an abstract question, if you like; but don't

try to judge. Leave individual cases alone. The matter is in
wiser and more loving Hands than ours . . . And be very
sure of one thing—that no lawful excuse exists for Barclay,
which will not, by-and-by, be taken into account. Every
possible excuse will be made—every difficult circumstance
and hardening influence will be allowed for. He will not be
expected to have done what he could not do; but only to
have done what he could do;—heredity, training, weak will,
and aught else, fully considered . . . Do you really think that
HE Who made the man doesn't know and understand all
this far better than you and I can do? Be reasonable, Jean!"
Jean's "Thank you!" was full of thought.
"Nothing is easier than to get into a tangle of perplexity—

looking through our limited peep-holes. You may dwell upon
heredity, and all that it entails, until you look upon a man as
a mere agglomeration of inherited molecules, unable to
move hand or foot, voice or will, except in obedience to
inherited proclivities. Or you may dwell upon training and its
results, until you look upon a man as a mere lump of
dough, pounded and rolled into a permanent shape, from
which he can never depart. But these are one-sided views.
Heredity has enormous influence. Training has immense
power. Nevertheless, through all, a man's will is free; and
for his actions, he is and must be accountable . . . After all,
few men are ready to carry out these pretty theories to
their legitimate end. If a thief comes, and makes away with
the plate, we don't say pityingly, 'Poor fellow! He can't help
it! He was obliged to act so! All the result of the bias he has
inherited from his father, and the want of a sufficient
inducement to be honest!' We treat him like a rational
being, with a will of his own, and clap him into prison.
Thereby, no doubt, supplying an inducement for the future."
Jem was glad to have made Jean laugh.
"Follow out that line of thought for yourself," he said, rising.

"Now, it is unsociable to run away so soon; but don't you
think I had better meet your father?"
"O Jem! Will you? How kind!"
"We shall soon be back, I dare say." As Jem was putting on

his great-coat, he said with rather an odd intonation—
"Cyril seems greatly taken with these Lucases! Is it—the

father—the mother—or—?"
"I don't know," Jean answered, startled less by the question

than by a sudden pulse of feeling through her own frame. "I
have not called yet."
"I have. The daughter is a nice little girl. Not quite desirable
for Cyril, though."
"Oh, I should not think—!" and a pause. "Yes, he is always

going there. But I thought it was Captain Lucas."
"Perhaps you are right. I hope so. Good-bye for the

moment."
Jean went slowly back to the drawing-room, thinking—not
of her father, but of Cyril. "Can it be?" she asked. "Cyril—to
marry Miss Lucas! Why didn't I see before?"
She tried to laugh, then threw herself back in an easy-chair;

an unwonted action for Jean, little given to lounging.
"Oh, how tired I am! I shouldn't have been half so tired if I

had gone up gorge! . . . Cyril to do—that! But why not? . . .
Cyril!"
She heard herself sigh, as she might have heard another

person sigh.
"Well—why not? After all, why not? If it will make him

happy!"
Nine o'clock struck before feet sounded on the gravel-walk;

and Jean hastened out to open the door. Mr. Trevelyan came
in slowly, leaning on Jem's arm.
"He's rather done!" Jem said cheerily. "But all right, now we
are back. The study, Jean—and he shall have some hot
brandy and water at once. No, I know he doesn't take
stimulants commonly; but to-night he must! We'll do our
best to keep out the chill. Smithson came half-way, and
then I sent him back."
Mr. Trevelyan did not speak till divested of his damp cloak,
and placed in his big chair near the blazing fire.
"This is nice," he tried to say, and the words were almost

too hoarse to be intelligible. "Fog—got into my throat," he
added with a smile.
"Father, were you in time?" asked Jean, as Jem went off for
the remedy he advised.
"Nearly an hour. He was past saying much—great pain—but

he listened—and I think he understood. I am glad you were
not there. The suffering was terrible."
"And—then—?" in a low voice.
The answer came almost like an echo of what Jem had said
—
"My dear, we can only leave him now—in just and merciful
Hands . . . ONE who knows all about him—better than you
or I! . . . But I would not for worlds not have gone."
Jean laid a hand on his, and it received warm pressure.

Whatever the consequences might be, she felt at the
moment that she had acted rightly.
CHAPTER X.
CONFIDENTIAL WITH THE DOCTOR.
"Far more numerous was the herd of such,

Who think too little, and who talk too much."
DRYDEN.
"I shall die if I don't talk."
REYNOLDS.
"THE world's in a queer state, Dr. Ingram," Mrs. Kennedy

remarked one January afternoon. "Uncomfortable, don't you
know?"
She spoke in a contemplative tone, lounging forward, while

a loose tail of hair obtruded itself from beneath a not too
tidy cap, and her placid gaze was riveted on the Doctor's
face. He had been summoned to prescribe for Dicky
something which should counteract a too unrestricted
course of Christmas plum-cake and "sweeties." The
Kennedy children were not trained to habits of self-control
in minor matters.
It was three o'clock, and the Doctor had a long list of visits
still to pay; yet he could not at once escape. Mrs. Kennedy,
though minus the possession of a "glittering eye," like that
of the Ancient Mariner, held him with such eyes as she had,
refusing to see his anxiety to be off.
"Generally is!" responded her companion.
He was in appearance not at all the stereotyped doctor of

novels. He was neither little nor bustling; and he did not
jerk out a succession of medical phrases, to mystify the
invalid's relations. Professionally, indeed, he was given to
saying a very small amount—some complained, a too small
amount—and what he did utter was rarely couched in
learned language. Of medium height, not too substantial,
yet not thin, he had reserved manners, which covered a
gentle and sympathetic disposition. His prevailing
expression was serious, but a substratum of humour
occasionally reached the surface, through superimposed
strata of a more solid kind.
Mrs. Kennedy's chief confidante was the Doctor's oldest

daughter, Mabel; but she had not the least objection to
confide in the Doctor himself, when opportunity offered.
"Uncomfortable, don't you think?" she repeated

meditatively. "Everything going cranky, you know. And
something ought to be done."
"To set the world right?"
"Well, but I mean, of course, our particular world.

Dulveriford, don't you know? I'm not talking about all sorts
of out of the world Tropics of Capricorns and longitudes and
things," said Mrs. Kennedy, with a vague recollection of
Dicky's last geography lesson before Christmas.
"Feejee Islanders are all very well—I dare say they'll learn
by-and-by quite to shine in society, don't you know?—Now
they've left off eating everybody. And as for Madagascar,
and Zulu-Land, and that other place—what is the name?—
Alaska—I should be as glad as anything, if they could just
have all the beads and blankets they want, poor dear
things! We have our working party once a fortnight, you
know—what Mabel calls 'The Timbuctoo Thimble'—and then,
of course, we think about those sort of creatures. At least,
we try to, I'm sure, though we do sometimes talk about
Mrs. Villiers' last new bonnet, don't you know?"
"And we read reports about them—quite properly! Because

my husband doesn't think we ought to read a story. I think
it might make folks work a little faster; but you know you
never can get a man to see what he doesn't see, when he
won't see it!—And he says it isn't suitable. And to be sure
we're not working for fictitious savages! But then everybody
yawns, and everybody else catches it and yawns too; and
nobody can do a nice hem when they're yawning, so we
have to stop reading and do a little talk instead . . . Still,
you know, all that can't be like home affairs!"
"And though I'm not so very desperately fond of Jean

Trevelyan in a general way—She's got a shut-up sort of
manner, you know, and all that—! And of course her father
and my husband are on different lines. I don't know why
they shouldn't be, either—" reflectively—"but I suppose it
isn't in man-nature to think that anybody or another line
can possibly be right. And so—don't you see?—That's how it
is! But Jean really is a nice girl, I'm sure—and all these
weeks I've been so awfully sorry for the poor dear! I
haven't liked to go and bother her through the worst of the
time—but now he's getting a little bit of a scrap better, I
thought I would just ask you—privately, don't you know?—If
I could be of any sort of use?"
Dr. Ingram's listening face relaxed slightly. Then this was

not all pure chatter.
"Of course, Jean has her own friends," pursued Mrs.

Kennedy, allowing no space for an answer. "Any number of
them. There's Mrs. Trevelyan—only she has been shut-up
for a month with influenza. And there's Mrs. Villiers—but I
shouldn't think she knew hardly as much about nursing as
my Dicky. She always looks as if she was meant to be
draperied like a Greek statue, don't you know?—With her
hands nicely arranged, so as to show off the wrists. That
funny creature, Miss Moggridge, has been backwards and
forwards every day, I'm told, but—What did you say? Oh, it
doesn't matter what I say to you, Dr. Ingram! You're like
Mabel! You never make mischief. And everybody thinks Miss
Moggridge queer."
"I'm afraid—" said Dr. Ingram, looking at the clock.
"I can't endure the woman, for my part. She's got such a
way of setting herself upon a turret, as if nobody else in the
world ever had a kind thought. Every one's narrow, and
bitter, and wicked, and disagreeable, except Miss
Moggridge. And the way she abuses good people who don't
think like her—! Well, of course they're narrow, poor dears
—and how can they help it? I suppose they were made so;
or at least they've grown into it. Some people are born
wide, and some are born narrow. And I don't really see, for
my part, that it's a bit prettier or more Christian, for the
broad-minded folks to abuse the narrow because they're
not broad, don't you know, than it is for the narrow to
abuse the broad, because they're not narrow, don't you
see? Of course, nobody ever calls themselves narrow. They
only say, they're all right, and everybody else is wrong who
doesn't think like them. And that's what Miss Moggridge
does—so where's the difference? . . . But I didn't mean to
get upon Miss Moggridge. I wanted to ask you about Mr.
Trevelyan."
Dr. Ingram hated to be questioned about his patients. He

immediately stood up.
"You're not going yet, you know," asserted Mrs. Kennedy,

keeping her seat. "My mind's all in a scrummage, and I
want putting straight. And I want to know first about Jean .
. . Of course, it's horrid for her, because she had to do what
brought on this illness. At least she thought she had to do
it. Yes, of course I've heard all about that—everybody has
heard it, and they all say it's just like Jean. Anybody else
wouldn't have called him. I wouldn't—not for any mortal
man living! Now do tell me—is Mr. Trevelyan going on well,
and could I do anything?"
"You can call and ask Jean yourself. She is much over-
taxed."
"I should think so—all these weeks of nursing! She won't

care to see me, not a scrap! So what's the good of my
going? Jean never did like me, and I don't see why she
should. It isn't opinions. People can like one another,
without thinking just identically the same about every single
thing that ever was heard of. But we don't suit somehow!
Only if I could be of any use? You can ask her for me. I
shan't go unless I'm sent for."
After this positive assertion, nobody at all acquainted with

Mrs. Kennedy need have been surprised that within half-an-
hour she was on her way to Dulveriford Rectory.
Jean came to see her when summoned. Her father was

asleep, she said; and one of the maids would keep watch
for a few minutes. Had Mrs. Kennedy come on business?
Jean looked pale and thin, with the stress of long nursing
and suspense, through her father's complicated and
dangerous illness. She had an air of rigid composure, as she
rang for tea, and sat down to answer Mrs. Kennedy's
questions.
Yes; her father was better; really better, and on the whole
out of danger. At least Dr. Ingram hoped so. Recovery would
be slow, of course; it could not be otherwise; and great care
would be needed. There must be no thought of work at
present—probably not for months. Dr. Ingram talked of a
year's rest. The strain had been kept up far too long.
Nothing was settled yet, but Dr. Ingram wished him very
much to go for a voyage—perhaps to the Cape, or perhaps
to Australia.
"My dear, I'm most dreadfully sorry! But you would go with
him, of course?"
"No; it would cost too much. One has not to think of

oneself," said Jean with a forced smile. "If it is necessary for
him—Yes; I suppose we shall have to get a locum tenens.
He could not start for another three or four weeks; and Mr.
Marson, who is helping now, can stay a little longer . . . Oh,
there is no difficulty about me. Jem Trevelyan and his
mother will take me in . . . Yes, my father knows—and of
course he will do what is right. I am only so thankful that he
is better. It might have been—!"
Jean counted her own self-command inviolable; but she was

not prepared to be taken into a large sympathetic embrace;
to have motherly kisses on her cheek; and to hear a
motherly voice saying, "You poor dear child! I am, so sorry."
Jean broke into one irresistible sob, and a few hot tears fell
in quick succession; but she struggled back to composure,
and gently released herself—not without a sense of comfort.
"Thank you very much: you are very good," she said. "But
of course I do not mean to be selfish. If he will only come
home strong, it will be all right. May I give you a cup of tea?
I am afraid I ought to go upstairs soon."
"I never quite knew before what nice feeling there is in

Jean," murmured Mrs. Kennedy as she trudged homeward.
"Really, she isn't half so stiff and shut-up when one gets to
know her; and she does seem so fond of her father. Perhaps
even he isn't always so starched as he seems sometimes!
—"
At almost the same moment, a somewhat similar thought

passed through Jean's mind: "How much pleasanter Mrs.
Kennedy is than I have always fancied!"
But neither could hear the other.
Passing through Dutton, Mrs. Kennedy turned aside near

the Post-Office, into a side street, where was a
greengrocer's, opposite a red house. Mrs. Kennedy had
taken to patronising this greengrocer of late from
economical motives. She gave an order for the morrow, and
walked out in time to see an active figure run up the steps
of the red house, turn the handle of the front door, and
enter.
"If that isn't Sir Cyril himself!" ejaculated Mrs. Kennedy

under her breath. "And as much at home as if—! Something
is in the air—that's certain! Poor dear Miss Devereux."
Of course Mrs. Kennedy knew all about the Lucases, since

family secrets were apt to ooze out in Dutton. She wisely
kept her own counsel, however, when she went home, and
said nothing—even to her husband. Through sheer
forgetfulness and absence of mind, he was apt to repeat
things which had no business to be repeated; and his wife
had learned through dire experience that silence is
sometimes the better form of discretion. Whether her
reticence would have survived a tête-à-tête with Mabel
Ingram may be doubted; but Mabel was from home. So
Mrs. Kennedy conjectured, and was mute.
She had made no mistake. It really was Sir Cyril Devereux,

who had run up the stone steps, and had entered lightly
without ringing.
He had been to the red house very often of late, oftener

than he realised. During the short period of convalescence
after his accident, he had paid many and lengthy calls on
the Lucases. Then came the break of his last term at
Oxford. And before Christmas, he returned home "for
good," a gentleman at large, with a comfortable property
and plenty of interests, but no definite line of work in life.
The property was large enough to require attention, but by

no means so extensive as to absorb the whole of a young
man's energies. Many beside Lady Lucas had earnestly
advised Sybella to provide some definite line for Cyril,
during at least the earlier years of his manhood; but she
had refused to see the need.
"He could take up anything he liked," she said; "but he

would, have plenty of money. For her part, she didn't see
why he need slave; and she was sure his health would not
stand hard work; and he might just as well live comfortably
at home with her! He could find plenty to do in Dulveriford."
Cyril had not opposed this view of the question. He was

vaguely desirous to make a "career" for himself somehow;
but he had not decided on the manner of that career. He
seemed to have no special bent beyond a general love of
art, and literature; and since, from a money point of view,
there was no hurry, he resolved to wait. Something would
turn up, sooner or later.
Meanwhile, his friends found consolation in the fact that at

least he was not disposed to idleness. He read a fair
amount, studied popular questions, looked into business
matters, went in for abundance of pedestrian and
equestrian exercise, and contrived on the whole to fill up his
time creditably. Sometimes he talked of setting up a hunter,
and sometimes he planned writing a book; but he had no
great passion either for hunting or penmanship. Sybella's
horror of guns had hitherto rather stood in the way of
shooting, except when he was away from home. Her horror
of cigars was less inconvenient, since, though not much
addicted to smoking as a habit, he could always retreat to
his den, when desirous to escape from her talk or her
temper.
In a general way, Cyril would have spent many a spare hour

at Dulveriford Rectory; but on his return before Christmas,
he found Jean still so entirely occupied in attendance on her
father, as to be rarely visible. As he could not have Jean, he
went in for Emmie Lucas.
He did not yet know his own mind about the two girls—
though not from any lack of self-watching—and he was
drifting fast to a position where he would be likely to act as
if he did know it.
Emmie's dark face, small and rosy and sweet, was gaining
more and more a hold upon him. She was not aware of the
fact herself, being very young, unversed in the ways of the
world, and kitten-like in simplicity. She would chat and
laugh with Sir Cyril, as easily as if she had been his sister,
delighted always to see him, because her father had so few
friends. But naturally, Cyril did not ascribe this delight to
thoughtfulness for her father—though he still kept up the
little fiction of coming perpetually to call upon Captain
Lucas. If Captain Lucas were out or busy, it was a matter of
course that he should stay for a talk with the ladies.
As already intimated, Cyril did not drift unknowingly. He

was too much given to self-analysing not to see whither his
barque floated. Sometimes he grew uneasy, and thought he
would not call on the Lucases for a few days; which "few
days" seldom extended themselves beyond two nights.
Sometimes he felt a desperate inclination to break through
everything, to get utterly away from Dulveriford for a year
or two years.
Why not? He had no binding duties at home; or anywhere
else, unfortunately. He had pottered abut a good deal in
Swiss and German hotels with Miss Devereux; but a wide
world unexplored lay beyond. Why not take a more
extended tour—say to the Antipodes—in search of a
vocation, or at least to see what the effect of separation
might be on himself and others? There was money enough;
and "aunt Sybella" could remain in charge at the Brow.
But these were evening and night thoughts chiefly. He said

nothing about them in the daytime.
Indeed, he seldom spoke of his friends, the Lucases, before

Miss Devereux; and she had as yet not the slightest idea
how far things had gone. Cyril had quite made up his mind
to do nothing hasty; to be drawn into no rash or ill-
considered step. He would see his way, clear as daylight,
before he would commit himself. Satisfied with this
resolution, he went on calling at the red house.
CHAPTER XI.
ON THE ROCKS.
"It is done! I have told her I love her!
• • • • •
"Some power grown tyrannous holding me fast,
Blotting alike the Future and Past."
L. MORRIS.
AFTER the evening call, witnessed by Mrs. Kennedy, Cyril

did not go again for three whole days. He really was unable,
being prevented by a close run of engagements: but none
the less he was much gratified with his own self-control in
staying away.
Emmie's little face haunted him incessantly, and after three

days, he could wait no longer. The Dulveriford world was a
wilderness without her smile. Friends came to lunch, and
more friends were expected to afternoon tea; and Sybella
always liked to air her nephew's manners on these
occasions. But Cyril, pleading business, slipped away soon
after three o'clock.
"Of course it is business," he told himself laughingly. "Much

more business than sitting indoors to talk chit-chat with a
lot of old maids. The most important business of life,
perhaps."
He had not so plainly allowed the possibility to himself

before; but under the pull of three days' starvation of
Emmie, it sprang up and took clear shape.
Nobody was in the drawing-room of the red house when he

entered, and the fire had sunk into a mere heap of red
embers—an unusual state of things there at four o'clock.
Cyril wondered what could have happened to banish the
three. They walked earlier, as a rule, these wintry days; and
engagements out to tea were rare.
Cyril endeavoured to warm his hands before the dull coals,
and considered whether he might count himself enough at
home to make up the fire, but did not do it. Then he strolled
about, criticised one or two of the old pictures, and finally
was rewarded by Emmie's appearance.
She did not see him at first. Her eyes were downcast, the
dark lashes almost resting on the rounded cheeks, and as
she came slowly in with a lagging step, she said, "O dear
me!" half aloud.
"How do you do?" asked Cyril.
Emmie's movement might have been the result of an

electric shock, and the dark eyes opened wide.
"Oh—I didn't see," she said in an embarrassed voice. "I—I

beg your pardon. Won't you sit down? I'll call my mother—if
—if she can come—"
"No, no, don't disturb her on any account. Pray don't. I dare
say she has lots of things to do."
"She has—she is—rather busy," faltered Emmie, and a look

of sorrowful trouble came to the sweet lips. "Oh, it is only—
she would come, if—"
"I dare say she will look in presently; but don't call her. I
only want to know how you are all getting on. The last three
days have been so full, I couldn't find a minute. How is your
father?"
"He—" Emmie shivered.
"Will you let me make up the fire? You are cold."
"Oh, no—I—"
Emmie knelt down on the rug, and poked vaguely at the red
embers; whereupon Cyril bent over her, took the poker out
of her hand which he found to be trembling, arranged the
fading coals in a scientific fashion, and placed a few fresh
pieces lightly one upon another. A flame sprang up as by
magic. Then he laid hold upon those trembling little hands,
lifted Emmie up, and placed her in the big arm-chair. She
submitted as a child might have done, and sat where he put
her, not crying as she would have cried for some minor
matter, but with her mouth set in a sorrowful curve, and her
eyes gazing into some unknown grief. The colour in her
cheeks was much deeper than usual—a rich crimson-velvet
tint—and the brow looked whiter, the eyes darker by
contrast. Cyril had never seen her thus. His feelings were
greatly stirred.
"I'm afraid you have been worried by something," he said

sympathizingly.
Emmie gave him a pathetic smile. "I suppose one has to be

worried sometimes," she said.
"And it's nothing I can help you in?"
"O no—thanks—"
"I would if I could. I would, really. You believe that—don't

you, Emmie?"
This was going on fast, much faster than he had meant to

go. The pathos and tender sorrow of her face were too
much for him, and wise resolutions were forgotten. He had
never called her "Emmie" before; and she scarcely seemed
to notice it, she was so full of her trouble. There was the
sound of a quivering sigh, and Cyril again took her hand.
"Emmie, don't you think you could let me help you?
Couldn't you manage to look on me as something more
than a mere friend . . . Yes, I mean it," as she turned
wondering eyes upon him; eyes so soft and sad that he was
carried away by their glance into a rush of pity and
affectionate concern. He had no time to analyse his own
feelings, to dissect the make of his sensations. Before he
knew what would come next, he was saying with pleading
earnestness—
"Emmie, I love you! I love you, darling! Can you love me?
Will you promise to be my wife?"
"It is so kind of you," said Emmie wistfully. Then she sat up,
and drew her hand away from his with an instinctive
movement, yet she repeated, "It is so very kind of you."
"Not 'kind,' Emmie. This is not 'kindness.' It is something so

much more. I don't think you understand."
"Yes—O I think I do. But I didn't know what you were going
to say. It seems so—so strange! And—my mother—"
"Would your mother object? Would she mind?"
"I don't know. O she couldn't—couldn't mind!" with a gasp.

"She would only—She would wish—She likes you so much
—"
"And you—you like me just a little too?"
"Yes. I like you—very much indeed," declared Emmie, her

face crimson and her breath quick. "Of course I do. Yes—
Only—But Miss Devereux—"
"Miss Devereux has no real control over me. It all rests with
you! If you can say 'Yes'—"

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1. Nutritional needs during pregnancy are affected by

2. A pregnant woman's energy needs must be met in order to

DIF: Cognitive Level: Knowledge REF: 175

5. Increased protein is necessary in pregnancy for

6. A good source of calcium during pregnancy is

7. A good source of iron during pregnancy would be

DIF: Cognitive Level: Knowledge REF: 175-176

8. Iron needs increase during pregnancy because of

9. Adequate folate in the periconceptional period helps prevent

11. Daily intake of vitamin C should be increased during pregnancy because it

DIF: Cognitive Level: Application REF: 175

DIF: Cognitive Level: Application REF: 179-180

15. A food choice to help alleviate constipation during pregnancy is

DIF: Cognitive Level: Application REF: 177-178

18. A pregnancy is considered high risk if the mother

DIF: Cognitive Level: Application REF: 180

19. A pregnant adolescent is at risk because she

DIF: Cognitive Level: Knowledge REF: 180-181

DIF: Cognitive Level: Knowledge REF: 180

21. During pregnancy, women should be encouraged not to

DIF: Cognitive Level: Knowledge REF: 182-183

22. The most common cause of anemia during pregnancy is

DIF: Cognitive Level: Application REF: 177

DIF: Cognitive Level: Knowledge REF: 185

DIF: Cognitive Level: Application REF: 185

26. Three important factors that support adequate lactation are

27. Nutrition counselors should encourage pregnant teenagers to

DIF: Cognitive Level: Application REF: 181-182

28. Advantages of breast-feeding for the mother include

29. During pregnancy, intake of caffeine for a 132-lb woman should be

DIF: Cognitive Level: Application REF: 183-184

30. The best food choice that provides a source of folate is

DIF: Cognitive Level: Application REF: 177

"Nothing pressing. It can wait till another day. I wanted to

He debated silently how soon to go after Mr. Trevelyan; a

"Yes; I can hardly think you would have been justified."

"No man is responsible for what he cannot help."

"Or for its results—"

"Or for results; so far as he has been absolutely powerless

"If Barclay had had a different home and education, he

"But isn't yielding or resisting a matter of will? And isn't will

"Yes—partly, no doubt. The natural will may be strong or

"And if a man's will is paralysed—?"

"I doubt if any sane man's will is paralysed. Most people

"But if the will is what it is, through heredity and training—"

"Not badly put, for a one-sided view of the question. But

"That brings one again to a man's surroundings. But

"Then one ought not to look into the question?"

"Look into it as an abstract question, if you like; but don't

Jean's "Thank you!" was full of thought.

"Nothing is easier than to get into a tangle of perplexity—

Jem was glad to have made Jean laugh.

"Follow out that line of thought for yourself," he said, rising.

"O Jem! Will you? How kind!"